A preliminary study on rectal dose reduction associated with hyaluronic acid implantation in brachytherapy for prostate cancer

doi:10.1016/j.ajur.2022.08.006

Asian Journal of Urology, 2024, 11 (2): 286-293 doi: 10.1016/j.ajur.2022.08.006

Regular Papers: Original Articles

A preliminary study on rectal dose reduction associated with hyaluronic acid implantation in brachytherapy for prostate cancer

Tairo Kashihara^a,*(

),Yuka Urago^b,c,Hiroyuki Okamoto^b,Mihiro Takemori^b,c,Hiroki Nakayama^b,c,Shohei Mikasa^b,Tetsu Nakaichi^b,Kotaro Iijima^b,Takahito Chiba^b,Junichi Kuwahara^b,d,Satoshi Nakamura^b,Weishan Chang^c,Yoshiyuki Matsui^e,Hiroshi Igaki^a

^aDepartment of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
^bRadiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
^cDepartment of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Ogu, Arakawa-ku, Tokyo, Japan
^dDepartment of Radiological Technology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
^eDepartment of Urological Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan

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Abstract

Objectives: Hydrogel spacer (HS) was developed to reduce rectal toxicities caused by radiotherapy, but has been reported to cause major adverse events. Our institute has attempted to introduce a hyaluronic acid (HA) as an alternative spacer. This study aimed to compare rectal doses and geometric distributions between the HS and HA implantation in prostate cancer.

Methods: HS and HA were inserted in 20 and 18 patients undergoing high-dose brachytherapy, respectively. The rectum spacer volumes injected were 10 mL and 22 mL, respectively. In the treatment planning system, 13.5 Gy was administered with common catheter positions. The rectal dose indices were assessed between the spacer groups for dosimetry evaluation. Distances between the prostate and rectum and configurations of the spacers were compared.

Results: The mean doses irradiated to 0.1 and 2 mL of the rectum were 10.45 Gy and 6.71 Gy for HS, and 6.73 Gy and 4.90 Gy for HA (p<0.001). The mean minimum distances between the prostate and rectum were 1.23 cm and 1.79 cm for HS and HA, respectively (p<0.05). Geometrical configuration comparisons revealed that HA has a higher ability to expand the space than HS.

Conclusion: The rectal dose reduction ability of HA is significantly greater than that of HS, suggesting its potential as a new spacer.

Key words： Brachytherapy Hyaluronic acid Hydrogel Prostatic neoplasm Radiotherapy

Received: 17 March 2022 Available online: 20 April 2024

Corresponding Authors: * E-mail address: tkashiha@ncc.go.jp (T. Kashihara).

About author:: ¹ These two authors contributed equally to this work.

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	Tairo Kashihara
	Yuka Urago
	Hiroyuki Okamoto
	Mihiro Takemori
	Hiroki Nakayama
	Shohei Mikasa
	Tetsu Nakaichi
	Kotaro Iijima
	Takahito Chiba
	Junichi Kuwahara
	Satoshi Nakamura
	Weishan Chang
	Yoshiyuki Matsui
	Hiroshi Igaki

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Cite this article:

Tairo Kashihara,Yuka Urago,Hiroyuki Okamoto, et al. A preliminary study on rectal dose reduction associated with hyaluronic acid implantation in brachytherapy for prostate cancer[J]. Asian Journal of Urology, 2024, 11(2): 286-293.

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http://www.ajurology.com/EN/10.1016/j.ajur.2022.08.006 OR http://www.ajurology.com/EN/Y2024/V11/I2/286

Patient demographic and clinical characteristics.

Comparisons of rectum D_x (x=0.1 mL, 1 mL, or 2 mL) with 2 types of the spacers. HS, hydrogel spacer; HA, hyaluronic acid. The marker (°) indicates the minimum distance in each patient between the prostate and rectum, and error bars indicate two standard deviations calculated from all results for each distance.

Comparisons of the mean rectal dose indices between the two types of spacers.

Comparisons of rectum dose parameters of V_y (y=1 Gy, 3 Gy, …, or 13 Gy) with two types of the spacers. (A) Results for V_y (y=1 Gy, 3 Gy, …, or 6 Gy); (B) Results for V_y (y=7 Gy, 8 Gy, …, or 13 Gy). HS, hydrogel spacer; HA, hyaluronic acid. The marker (°) indicates the minimum distance in each patient between the prostate and rectum, and error bars indicate two standard deviations calculated from all results for each distance.

Minimum distances between the prostate and rectum as a function of the spacer volume in all axial planes of computed tomography scans for each patient. Error bars indicate two standard deviations calculated from all results for each distance. HS, hydrogel spacer; HA, hyaluronic acid.

Fused contours of the prostate (red lines) and spacers (cyan lines) and representative structure of each type of spacer (blue line). (A) Hydrogel spacer; (B) Hyaluronic acid. Top: axial section; bottom left: sagittal section; bottom right: coronal section.

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